Employment Development Initiative

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1 Employment Development Initiative Fiscal Year 2011 & 2012 Projects Overview

2 Alphabetical Index Alabama (FY11). p. 5 Connecticut (FY11) p. 7 Georgia (FY11)... p. 9 Iowa (FY12) p. 11 Michigan (FY12) p. 13 Missouri (FY11).. p. 15 Nebraska (FY12) p. 17 New Hampshire (FY11)... p. 20 New Jersey (FY11).... p. 22 New York (FY11)... p. 24 North Dakota (FY12).. p. 26 Pennsylvania (FY12) p. 28 Rhode Island (FY12) p. 30 South Carolina (FY12). p. 32 Texas (FY12) p. 34 Vermont (FY11).... p. 36 Virginia (FY12).. p. 38 Wisconsin (FY11)..... p. 41 Appendix p. 43 2

3 It is with pride that I congratulate the Employment Development Initiative (EDI) Awardees of Fiscal Years 2011 and 2012, representing 18 states and projects. The effort and leadership of each state in providing innovative models, guiding our systems to identify, adopt, and strengthen programs to create and keep jobs for those served in the public behavioral health system, has been exemplary. By targeting flexible, tipping point resources to behavioral health communities, the EDI initiatives have shown clear evidence of success through the past 2 years. EDI supports efforts that work with the present reality of very limited resources to show what can be accomplished to achieve important goals in more effective ways. Each of the initiatives embodies a spirit of expertise, resourcefulness and innovation to address significant employment needs that demand creative responses, unique to each state. SAMHSA/CMHS will continue to support efforts such as the EDI that leverages positive system change in states and local communities coming together, sharing ideas and facilitating peer-to-peer technical assistance to accomplish measurable goals. We are proud to have partnered in these successful projects and offer heartfelt Congratulations! Together we are transforming behavioral health care in America! Paolo del Vecchio Director Center for Mental Health Services June 16,

4 Introduction America has always struggled to care for and support people who have mental illnesses. The challenges of addressing these disabling health conditions demand that we show our compassion and our ingenuity. Regrettably, many of the problems noted in the 1970s (during the Carter Mental Health Commission) remain, but there have been some exciting developments, especially the expectation of recovery now for people with mental illness. ---Former First Lady Rosalynn Carter Even in ideal economic conditions, the rate of unemployment among working age adults with psychiatric disabilities ranges from 70 percent to 90 percent. ---NASMHPD Technical Assistance Tool Kit on Employment for People with Psychiatric Disabilities Former First Lady Rosalynn Carter s statement very clearly describes the realistic expectations that our systems should empower people to recover from mental illness. Knowing that meaningful employment is a key component of any journey to recovery, the statistic above from the NASMHPD Tool Kit illustrates the substantial work required to improve hiring rates of individuals with mental health and substance use disorders. In light of these realities, in 2011 SAMHSA s Center for Mental Health Services (CMHS) created the Employment Development Initiative (EDI) to assist in this essential work. This project provides, on a competitive basis, modest funding awards to States, the District of Columbia, and the Territories. For each of FY 2011 and FY 2012, CMHS awarded grants averaging $103,000 to nine (9) States. In addition, each grantee received two (2) consultant technical assistance visits coordinated and paid through NASMHPD s portion of the project. These flexible funds were used to identify, adopt, and strengthen employment programs and activities that can be implemented in the State, either through a new initiative or expansion of one already underway, and can focus on any portion of a state system working to improve or create employment opportunities to those served in a public behavioral health system. This overview document highlights the successful outcomes for these eighteen (18) projects. If you would like more specific detail, in-state contact information is provided on each project page. Also feel free to contact NASMHPD s EDI Project Director with questions as well at: David Miller NASMHPD Project Director 66 Canal Center Plaza, Suite 302 Alexandria, VA Phone:

5 Alabama FY2011 EDI PROJECT: 1. Statewide needs assessment; 2. Develop Advisory council and strategic plan; and 3. Develop and implement a statewide employment training program KEY OUTCOMES: GOAL 1: Conduct a cross systems needs and resource assessment A statewide needs-assessment was developed and implemented which examined current employment services and staff training programs provided in the community for adults diagnosed with a mental illness and/or substance abuse disorder as well as identified gaps in employment services and opportunities. The four stages of the needs assessment included: 1.) A systems gap analysis 2.) Identification of priorities and importance 3.) Identification of causes of service gaps and 4.) Identification of possible solutions and growth opportunities. The systems gap analysis included a comprehensive review of current employment programs and resources available, internal and external constraints, and the necessary conditions needed for systems improvement. To capture opinions of the current and desired situation, evaluations and focus groups were conducted with consumers, mental health and substance abuse professionals, family members, and other key stakeholders. The EDI flexibility and nonprescriptiveness allowed Alabama to be creative. GOAL 2: Develop a Department of Mental Health Employment Advisory Council & Statewide Employment Strategic Plan After the completion of the gap analysis, DMH developed statewide cross-systems, Employment Advisory Council (EAC) that includes family and consumer representation as well as representation from the following: Alabama Department of Rehabilitation Services, Alabama Association for Persons in Supported Employment, Alabama Peer Specialist Association, Alabama Medicaid Agency, Social Security Administration, Alabama Work Incentives Network (ALAWIN), the Alabama Department of Labor to include local Career Center representation, the Alabama Department of Economic and Community Affairs, WINGS Across Alabama Statewide Consumer Organization, NAMI Alabama, Mental Health America, Alabama Department of Education, FORMLL (statewide substance abuse consumer advocacy group), Alabama Disability Advocacy Network, Alabama Chamber of Commerce, Governor s Office Staff, Governor s Office on Disability, Business Council of Alabama, Alabama Council of Community Mental Health Boards and representatives from local Substance Abuse Providers. Utilizing information gathered from the needs assessment, the EAC developed a statewide cross systems employment strategic plan which identified goals, action plans, tactics, an interagency SWOT analysis, 5

6 emergent strategies, and performance measures. The overarching goal of the strategic plan was to increase competitive employment outcomes for individuals with mental illness and substance abuse through the use of the supported employment model, peer support specialists, and other identified evidence based practices. The EAC initially identified the priorities for the employment initiative and develop strategies for addressing the various barriers. Further, the EAC worked to enhance collaboration among state agencies through memorandum of agreements to expand funding through the utilization of shared resources. Dartmouth University assisted in the facilitation of the EAC kick off meeting and addressed the potential of Alabama becoming a Dartmouth Pilot State for their Johnson and Johnson funded Evidenced Based Supported Employment. GOAL 3: Develop and implement a statewide employment training program for consumers & family members, EAC members, DMH staff, community providers, and other community stakeholders In conjunction with the EAC, DMH held its first Train the Trainer Program for the MI Certified Peer Support Specialist Program in October DMH s goal is to have peer specialists hired at every mental health center and to expand the capability to train consumers to be certified as peer specialists. Stemming from this initial training, two pilot consumer training events were then held. DMH has been working with the Appalachian Consulting Group for several of the trainings. Individuals were trained in the basics of supported employment. This has provided DMH with an ongoing resource that will allow the state to continue training peer specialists without the cost of utilizing out-of- state trainers for each training session. It will also provide the opportunity for additional consumers to be certified and potentially employed as a Certified Peer Specialist in the community. A peer support Specialist Training was also held for individuals with a substance use disorder. Along with expanding the Certified Peer Support Specialist program, DMH implemented a Supported Employment Educational Workshops which has helped to shift attitudes, educate and eliminate misconceptions regarding the loss of benefits and the consumer s ability to work. Consumers, family members, community providers and other key stakeholders received basic training. The training was developed utilizing the SAMHSA Supported Employment Evidence Based Practice Kit and technical assistance support. Four regional trainings were held, with 150 attendees total. These meetings provided an overview of employment options for consumers with a mental illness or substance use disorder. Meetings featured the trainings and documentary of George V. Nostrand, who has not only seen how work helps people with mental illness and substance abuse with their recovery, but he has experienced it first hand - work was one of the most important elements to helping him regain self-confidence, feel worthy again, and provide direction for him. Additional results: This was the first peer support credentialing effort in Alabama. This project has really helped impress upon Alabama s Medicaid agency the importance of supported employment. The EAC continues to meet. The DMH linkage with the Department of Rehab Services has been significantly strengthened, as has the relationship with Voc-Rehab. A state plan amendment for Medicaid reimbursement for rehab option peer services is being developed. For more information, contact: Byron White Consumer Employment Specialist Phone:

7 Connecticut FY2011 EDI PROJECT: Entrepreneurial mini-grants for consumer established small businesses KEY OUTCOMES: Over 150 individuals with psychiatric disorders or psychiatric and co-occurring substance use disorders with self-stated goals of entrepreneurship participated in statewide informational forums and ongoing training and TA supports. All DMHAS employment provider agencies including over 100 staff were given an overview of the project and asked to distribute information to consumers in their programs. They actively recruited participants for the project. 35 persons in recovery participated in the two-day consumer training. 38 employment/housing provider and advocacy organization staff participated in the one-day provider training. 12 individuals with psychiatric disorders or psychiatric and co-occurring substance use disorders were awarded an entrepreneur mini-grant. The Advisory Committee and CT Small Business Development Center Business Advisors teamed to select 12 recipients of mini-grants based on the viability of the business plans (out of 23 that had been submitted for funding). Those plans that were selected were deemed feasible business models and good market fits. Awardees demonstrated the requisite financial means and skills set. Given the poor economic environment in CT, the Advisory Committee chose to fund fewer plans, focusing on those that appeared the most viable and sustainable rather than those with less potential. Grant funds were committed to purchasing intensive technical assistance for persons receiving mini-grants. 100% of individuals with psychiatric disorders or psychiatric and co-occurring substance use disorder awarded an entrepreneur mini-grant received ongoing training and technical assistance. All participants in the consumer training received one-on-one TA from the SBDC Business Advisors while preparing their draft business plans. The 12 persons receiving mini-grants continued to receive one-on-one business-related TA for as long as needed while starting up their businesses. Businesses included a tax accountant, a cab driver, house cleaning, yard maintenance, an ebay seller, and a lawyer whose focus is kids with special needs. All participants received one-on-one follow-up personal supports, both during the business plan preparation phase and following the announcement of the mini-grant awards. Efforts were made to link those whose plans were not funded with other resources and supports. Additional workshops were purchased from business experts on topics of interest including marketing, legal aspects 7 This award went directly to the hands of consumers, and it allowed them to do things they never could have done they can t go to a bank!

8 of running a business, managing budgets and credit. Participants were connected with fiduciary agents, who managed their grants. In-depth benefits counseling was arranged for those whose benefits would be affected by their small business earnings. All awardees were on SSI, SSDI, etc 76% of DMHAS-funded mental health supported employment service providers participated with training and technical assistance aimed at increasing their capabilities in supporting individuals in recovery with self-stated goals of entrepreneurship. 38 providers and staff from advocacy organizations participated in the provider training, representing 25 agencies (or 76%) of the 33 that receive DMHAS funding. All DMHAS-funded employment and housing providers received the DMHAS Small Business Development Toolkit that contains information on small business start-up strategies and resources. The toolkit, coupled with the staff training provided through the grant, constitute the newly formed DMHAS infrastructure that can support future entrepreneurial efforts among persons in recovery. Additional Findings This project demonstrated that entrepreneurship is indeed a viable option for persons in recovery. The Business Advisors from the Small Business Development Center (SBDC) observed that the business plans submitted by the individuals in this program were stronger and demonstrated more commitment than those of the general population. All of the persons receiving mini-grants as well as the majority of persons who were not were encouraged by their Business Advisors to continue working on their business plans, which the Advisors felt had real potential to succeed with additional effort. Key to the success of the project was the public-private partnership that was established between the Connecticut Small Business Development Center - those with the business expertise - and DMHAS in collaboration with the state s advocacy organizations - those with knowledge and experience in supporting persons in recovery. Decisions regarding the training content/format and mini-grant awards, as well as the ongoing personal support of the participants, benefited from the collaboration of both parties. As a result, the project ran smoothly and was consistently tailored to the specific needs of the population. Longer-term tracking of business outcomes - over the period of at least one year - will allow DMHAS to monitor participant progress toward starting their businesses and determine additional needs for personal support and technical assistance. To date all but one business has been moving forward as planned. Several took advantage of the season (tax accounting and lawn maintenance businesses) to solicit customers. Project staff are publicizing grant outcomes on the DMHAS website and via statewide presentations. Staff are pursuing resources to offer the project again in the future. Through benefits counseling and the use of Individual Development Accounts and PASS Programs, the grant has helped people who were fearful of losing SSI/SSDI cash benefits to move toward financial independence. Most of the grantees have increased their earnings and are working toward self-sufficiency. Providers have been supportive towards these future entrepreneurs. The SBDC, whose assistance has been instrumental, has been surprised at how well thought out the proposals have been. The SBDC examined these proposals in a cold, pragmatic way which DMHAS could never have done. Voc-Rehab teamed with DMHAS to assist several entrepreneurs to sustain their businesses. For more information contact: Ruth Howell Employment Services Coordinator Department of Mental Health and Addiction Services 410 Capitol Avenue, Hartford, CT Phone:

9 Georgia FY2011 EDI PROJECT: Integrating increased evidence based practices into Georgia s supported employment portfolio. KEY OUTCOMES: The 20 th annual Georgia Mental Health Consumer Network (GMHCN) statewide consumer conference, held in August 2011, set a new tone for Georgia s consumers by focusing on employment as a means to recovery. George H. Brice, Jr. MSW, from the Integrated Employment Institute in Stratford, NJ, gave a moving plenary speech in which he described the importance of employment in his life. George remarked that he wished someone had invested more time with him when he was 26 to support his employment, rather than enrolling him for Social Security Income (SSI) benefits. The EDI award also funded four conference workshops, each held twice, on vocational goals. George Brice, plenary speaker, spoke on Improving Employment Outcomes: Peer Delivered Wellness Coaching. Charles Willis, Self-Directed Recovery Project Director, GMHCN discussed use of WRAP for Work. Sally Atwell, Benefits Navigator at Shepherd Spinal Center discussed SSI/SSDI related issues associated with employment in Returning to Work. And Colleen Walsh, CPS shared her personal journey from diagnosis to work on a master s degree and the many resources available to consumers on college campuses in her workshop, Recovery on Campus: Navigating Higher Education. 532 consumers attended. WRAP for Work workbooks were distributed to each participant; and 36 staff and consumers from the Supported Employment Collaborative (SEC) pilot partner agencies attended the conference on full scholarships paid for with EDI funding. Every year participants vote on five priorities important to their recovery for which they want the GMHCN to advocate. This year, Educational Opportunities, Supported Education/Job Training was identified as the fifth priority. And by a significant margin, Jobs/Employment/Supported Employment was voted the number one priority. DBHDD formed a number of working partnerships, including one with Georgia s Department of Labor, Vocational Rehabilitation (GDOL/VR) program. GDOL/VR has agreed to participate in our SEC pilot study by assigning a local Voc-Rehab Counselor to each SEC pilot site, and has recognized the need to train VR counselors in Individual Placement and Supports (IPS) model of supported employment (an EBP) and to learn more about the employment potential in individuals living with severe and persistent mental illness. DBHDD is now working on a memorandum of understanding with GDOL/VR to formalize their working relationship. 9 Employment needs to be a State commitment every step of the way, much like recovery concepts. It cannot be forgotten or shunted aside as we focus on other services, such as signing up people for SSI or other benefits

10 One of the challenges encountered in the implementation of the SEC pilot study was confirmation of pilot participants. Each SEC pilot site must have an ACT team, a Supported Employment (SE) provider and a Peer Support (PS) program. Georgia s behavioral health provider system is unique due to privatization prior efforts. Some of the providers who operated as traditional community MH/AD/DD centers have retained their characteristic provision of a full array of services to all disability groups. Others have limited their array, and literally thousands of non-profit and for-profit providers have entered the system to provide specialty services like Peer Support, ACT and Supported Employment services. Providers can thus have between 0-3 of these services. Georgia s provider system presents a challenge to implementing a critical component in IPS SE, the integration of treatment and employment services. Therefore, Georgia has selected three different configurations of ACT, SE and PS providers for each SEC pilot site. One SEC pilot site is a traditional provider of all three services. Another site consists of a non-profit provider of SE and PS services and another partner that provides ACT. And, the third site will involve three different agencies that provide each provide only one of the services (a potential barrier to collaboration). Lessons from these pilot sites will ultimately be applied statewide. Three webinars (Introduction to IPS, Customized Job Development and Other Elements to SEC), were provided to teach all participants about the principles of IPS. Teleconferences, on-site technical assistance and consultation will be provided collectively and separately to each SEC with the goal of helping them infuse IPS principles. The pilot sites also participated in a focus group to assist in identification of key elements to be included in the Peer Supported Employment curriculum. After creation of the curriculum, three one-day trainings (and additional on-site TA) were provided across the state to train 10% of Georgia s Certified Peer Specialist workforce. 60 people were trained. This curriculum will be integrated into the Peer Specialist curriculum and CPSs employed in Peer Support and other DBHDD services will help transform consumer, provider and public attitudes about the ability of individuals with serious mental illnesses to engage in meaningful employment and have professional careers. Development of these partnerships also forms the basis for a successful and impactful Supported Employment Summit at the Carter Center, held June 8, 2012, brought together a nationally recognized national and local stakeholders to share the lessons and opportunities gained through the SEC pilot study; promote the use of Peer Supported Employment; and chart a path to maximize Georgia s resources to increase employment opportunities. 109 attendees (including GA DOL and Voc-Rehab). Primary speakers were Lisa A. Razzano, PhD, CPRP, Associate Professor & Deputy Director, Center for Mental Health Services Research & Policy, University of Illinois at Chicago, and Chris Button, PhD, Supervisory Policy Advisor, Office of Disability Employment Policy, U.S. Department of Labor. For more information contact: Mary Shuman, MS, CPS Adult Community Mental Health Department of Behavioral Health & Developmental Disabilities (DBHDD) 2 Peachtree St., NW, Atlanta, GA Phone:

11 Iowa FY2012 EDI PROJECT: Self-Employment Initiative KEY OUTCOMES: Funds were used in a two-pronged approach: (1) providing Technical Assistance (TA) seminars to mental health administrators and providers regarding earning financial incentives for individuals who establish successful entrepreneurship; and (2) conducting Self Employment workshops to help people explore and establish self-employment ventures. Technical Assistance Seminars Subcontractor Griffin-Harnmis and Associates (GHA) performed three TA seminars for mental health administrators (especially CMHCs) throughout the state. Attendees were typically representatives of Mental Health & Disability Services, IDHS facilities, Community Mental Health Centers, County Central Point of Coordination Administrators, Iowa State Association of Counties, Iowa. These three seminars were: 1. The Possibilities of Self Employment for your Customers, attended by 39 people. 2. Using Benefits to Achieve Self Employment, attended by 38 people (82 registered); at least 18 were from direct service providers. 3. Expand Your Organization's Resources While Supporting Clients to Seek Self Sufficiency: Ticket to Work ; had 26 participants. This webinar focused on how Community Mental Health Centers and other Providers can become Employment Networks under Ticket to Work. Self-Employment Workshops Six 2-day Self Employment workshops were provided for individuals with mental illness to help them explore and establish self-employment ventures. The Self Employment workshop uses the same agenda and materials each time. Seminar participants learn about the principles of small business ownership and the unique resources that exist through Social Security and other national, state, and local resources that support entrepreneurs with disabilities. Following the seminar, a local network of Business Planners, trained and supervised by GHA, was available to provide assistance with writing a business plan or accessing resources. In addition, certified Benefits Planners help assure that Social Security work incentives are maximally utilized while Medicaid healthcare benefits are preserved. After the first two workshops, there was concern that the turnouts were lower than expected, so a revised marketing plan was established, including advertising in more places (such as in the Governor s Disability Council newsletter Infonet and in in the ASKresources web-based-newsletter) and in adjacent counties. So, for example, for the Dubuque seminar on June 26-27, the mailing went to all MEPD and HCBS members age in these counties: Dubuque, Delaware, Jones, Jackson, Clayton, Fayette, Buchanan, Linn, Cedar, and 11

12 Clinton (which is 5 more counties than they would have before). The six workshops were: April 24-25:1 st Self Employment 2-day seminar in Sioux City IA, attended by 6 people. April 26-27: SE Seminar in Council Bluffs, attended by 5 people. June 26-27: SE Seminar in Dubuque, attended by 10 people (five people signed up for one-on-one technical assistance). June 28-29: SE Seminar in Davenport, attended by 21 people (eleven (11) one-on-one sessions). August 14-15: SE Seminar in Waterloo, attended by 19 participants (seven one-on-one benefits planning/business consulting sessions). August 16-17: SE Seminar in Des Moines, attended by 31 participants (eleven one-on-one benefits planning/business consulting sessions). Additional workshop follow-up included mailing program binders and CDs to interested parties who were unable to attend and follow-up with constituents from previous Seminars. Additional activities related to the workshops: o June 19-20: staffed a table of Employment information at the Iowa Advocates for Mental Health Recovery conference, attended by about 200 people; handed out 50 flyers about the 2-day Self Employment seminars and the upcoming Webinars. o August 7-9: staffed an Employment table at Iowa Empowerment conference, attended by 180 persons with primarily mental health disabilities. Invited several vendors (service providers) to the Aug 13 th Webinar on becoming an Employment Network under Ticket to Work. o Received 13 contacts/requests for further business planning; plus 59 constituents with further questions via . A number of consumers have already launched, or are about to launch, their own businesses. They include: Jim K. of Mason City started a PediTaxi-and-Tour business with his rickshaw. A tour of Mason City s downtown includes the Historic Park Inn Hotel, Architectural Interpretive Center, Stockman House, the footbridge and Music Man Square. Link to story at Paula J., Council Bluffs, selling home-made items including greeting cards, baby clothing, tote bags, and aprons. Anne Y., Des Moines, Serenity Enhancements online, selling 12-Step related items. One of the participants had previously been a real estate agent but had let her license lapse. She has since renewed her license and brought in about $4,300 in profit for 2012 and is still in business for herself and working hard to keep it going. Another participant has decided to go to school to get his Masters in Nursing. GHA has connected an Iowa Business Planner with 11 constituents for further business planning. For more information, contact: Lin Nibbelink, LISW IDHS Division of Mental Health and Disability Services 1305 E. Walnut, Des Moines, IA Phone:

13 Michigan FY2012 EDI PROJECT: SE Education and Training including Benefits Counseling and Supervisor Training KEY OUTCOMES: In the year and a half since the inception of the EDI funding opportunity, IPS has taken a foothold in the state of Michigan. Michigan has seen an increase in our IPS program numbers from 16 existing programs to 37! This is measured by the number of programs receiving fidelity reviews, Michigan does know that there are a minimum of 3 additional programs who simply do not feel that they are at a stage where they feel comfortable being reviewed. Michigan has also experienced an 18% increase in getting people into employment programs and back to work. Michigan, through its EDI project, focused on four barriers which have limited prior employment projects in the state. The most significant barriers to success is the long-standing notion that employment is someone else s issue to deal with. This belief decreases the opportunities to provide integrated services with mental health treatment. Most organizations see the efforts as coming only from a vocational/employment team, and do not make the necessary changes within their administration. Secondly, the ongoing lack of understanding of the impact of work on benefits (and of benefits on work status) is significant. Another significant barrier is the skill level and credibility of the Supported Employment staff, including the timely dissemination of basic introductory information on the model. Developing the skills and knowledge to consistently perform the necessary tasks not only increases the opportunities for success for the individuals receiving services, it also adds to the professional credibility of employment staff on the multi-disciplinary mental health treatment team. The lack of more accurate data collection is final area that poses a barrier. Without accurate information to give back to the local communities and our key partners (i.e. Vocational Rehabilitation), success cannot be demonstrated in a meaningful way and encouragement for accomplished gains is compromised. These barriers were addressed in a number of specific areas, including: 1. Enhancing the development of as an informational vehicle to the general public regarding evidence-based practices in Michigan, and as a learning tool for EBP practitioners across the state. EDI funding furthered the development of the EBSE information and EBSE-101 course as well as the further development of an interactive wikipedia, web-facilitated learning collaborative, web-facilitated just-in-time practice consultation/supervision, practitioner-to-practitioner support and idea exchange, and more. The Improving MI Practices website is active and user friendly. There is a great deal of maintenance and upkeep-it has proven to be a large undertaking. The next step is to explore working with an established web-based training team to explore merging the site with their work. 2. Established criteria and implemented a process of choosing local programs which are motivated, willing and able to work toward a high fidelity EBSE status with an increase in competitive employment outcomes. By choosing programs which, at minimum, have a baseline fidelity review already established for benchmarking purposes, 13

14 subsequent implementation, technical assistance and support could quickly be advanced. The MIFAST-SE team can be quickly deployed to begin technical assistance, training, or reviewing programs, and assisting in the development of providers quality improvement plans. 3. Comprehensive and individualized benefits counseling is a key to success. Michigan has a strong Work Incentives Planning and Assistance (WIPA) program, however, there are not nearly enough available WIPA services to meet the demand across the state. Michigan has recently started offering Benefits Information Network (BIN) training to many providers (including Peer Support Specialists). This training is a comprehensive 4-day training accompanied by field study and an exit test in which a participant must score an 80% to pass with a certificate of completion. For those who successfully complete the training, they are supported via monthly technical assistance calls with the intent to grow a network across the state. This training has also been supported by Medicaid Infrastructure Grant funds and is designed to enhance the Social Security CWIC (Community Work Incentive Coordinator) initiative in Michigan. Throughout the year, 73 people have been trained via the Benefits Information Network. This offers Michigan s consumers a greater access to individuals with the knowledge to assist them in understanding their personal benefits situation and the impact of work. A number of consumers across the programs are working one-on-one with their BIN staff and for their Work Incentive Planning Administrator on moving from part time work while maintaining their benefits to full time work with private insurance via their employer. Michigan is currently working on creating a second round of this valuable training. 4. Provided two 2-day EBSE skills trainings for employment staff and supervisors. For those programs selected as part of #2 above, these trainings were followed up with technical assistance onsite at their location to ensure practical application. 5. Collaborated with a motivational interviewing training provider to determine the most effective method for training employment staff. The application of this set of skills in support of gaining employment has some application differences when compared to applications in a therapeutic environment, and training differently would have advantages. 6. Developed a supervisors learning collaborative, to further sharpen skills, to problem-solve and to provide a venue for ongoing support from colleagues. This collaborative included a one-time, supervisors conference, followed by monthly technical assistance calls, webinars, and other hosted virtual interactions via The development of a Supervisors' Learning Collaborative has been an essential component for all the program leaders who are involved. This has allowed Michigan to share tools, suggestions and other supports - deepening the supports supervisors feel they have in getting their programs running well. Michigan continues holding monthly Supervisor s Conference Calls to share ideas, problem-solve and resource share. These calls are assisting the development of their second annual IPS Supervisor s Training that will be held the summer of Additional next steps include: From a system perspective, MDCH is experiencing a great deal of interest from providers and legislators in employment for people with disabilities. There is a great deal of discussion occurring in the state around definitions of different levels of employment and for vocational activity. Another result of our increased partnership with our VR partners, we are currently collaborating to guide the field in maximizing their local CMH/VR relationships. Michigan has initiated a data collection pilot to determine a baseline look at on which vocational services the state is directing the most resources, from this look, we will then strategize the best method for influencing the allocation of precious resources to the highest level of integrated/competitive employment All in all, the IPS efforts in the state of MI are moving forward, critically the Department has committed to continued support and assistance for the next fiscal year! For more information, contact: Amy Miller, Supported Employment Program Consultant Behavioral Health and Development Disabilities Administration 320 South Walnut Street, Lansing, MI Phone: ; 14

15 Missouri FY2011 EDI PROJECT: 1. To strengthen peer delivered services in Missouri by leveraging Medicaid billing for services provided by Certified Peer Specialists in Consumer Operated Programs (COSP); 2. To Introduce and begin implementation of peer delivered Individual Placement and Supports - Supported Employment (SE) - in Consumer Operated Programs. KEY OUTCOMES: Goal 1: To strengthen peer delivered services in Missouri by leveraging Medicaid billing for services provided by Certified Peer Specialists in Consumer Operated Services Programs (COSP): The background leading to the need for this goal includes the way Missouri Medicaid services are organized and delivered. Missouri has an Administrative Agent system of CMHCs; all Medicaid Rehabilitation Option billing must be done thru this system. Considerable progress has been made with training and certifying peers to be Missouri Certified Peer Specialists and when they are employed by the CMHC s there is an established billing code to permit the Medicaid match. The Consumer Operated Programs (COSPs) by their very nature, are not part of the conventional mental health system, and thus, are not administratively eligible to bill Medicaid. This has meant that the COSPs have not been able to leverage federal participation for the services of their Peer Specialists. Missouri developed a strong relationship with one of its Administrative Agents: Places For People, who agreed to work on exploring what it would take to pass thru the billings for Certified Peer Specialists. Meetings were held to acquaint the COSPs about Medicaid rules and carefully scrutinize the role of the Mental Health Professional in the process. Data was collected by the COSPs about the Medicaid status of the individuals they serve in all locations around the state. The original plan had been to start in St Louis, where Places For People is located, but as a result of the survey it appeared that other locations had more eligible people as well as more people who were dually served by the COSPs and CMHC s. It also became clear that the rules and practices concerning billing for individual one-to-one Community Support were greater barriers than the procedures for billing group Psychosocial Rehabilitation (PSR). In fact, two of the COSPs had peripheral activity in this area in the past, and one of them is indeed billing via PSR. We are now considering the benefits of adding a specific billing code tailored for COSP rather than attempting to retro-fit the COSPs to existing codes. This work continues and we are cautiously optimistic about achieving success in this way. Missouri met with Consumer leaders from New York and Ohio to hear more about how those organizations have leveraged Medicaid funds and also contracted funds from Managed Care Organizations. Missouri continues to work on this goal, and as state policy teams ascertain how to organize the system to permit 15 Because it was flexible, EDI made all the difference. We also noted that sometimes you can do more with flexible, small amounts, than you can with big, restricted, funds.

16 Medicaid billing Missouri has contributed state funds to ensure that this initiative continues. Goal 2: To introduce and begin implementation of peer delivered Individual Placement and Supports Supported Employment (SE) in Consumer Operated Services Programs: Missouri had a head start with this activity because Mickie McDowell, a Consumer Consultant (full time paid position), has been spending half of her time working with the COSPs and the other half working with our Johnson & Johnson Dartmouth Community Mental Health Programs Supported Employment teams. Missouri began by analyzing the elements of Fidelity SE and comparing them to the capacities and the interests of the COSPs. It became clear that many elements of SE were in synch with the abilities of the COSPs to provide them, most particularly the personalized employment profile that is needed to help people think through their employment history and wishes for the future. Some of the activities that have occurred under this goal include: Numerous meetings held with the COSP participants to discuss aspects of employment, and included one-on-one discussions creating the beginnings of employment plans; Presentations at the COSPs by Social Security reps to explain the work incentives available and discuss the consequences on Medicaid eligibility; Participation by some Peers in the beta testing of the web based tool called DB101 which is an application that has a person plug in their personal financial information and then see what happens to benefits as earned income increases. This tool is in use in California, Michigan, Minnesota, and at least one or two other states, and is tailored by the developers for each state; Consumers from all of the COSP s attended the Real Voices; Real Choices annual Consumer Conference. At this event, an open discussion was held with the Director of the Department of Mental Health and the Division Directors on the subjects of housing and employment. Consumers were vocal in their desires for work and their frustration at the many barriers they face; David Lynnd, an experienced IPS trainer who is affiliated with Dartmouth University visited all of the drop-in centers and performed an on-site review of each site. A work-plan was developed for each, including how sites can assist with employment and social security for people; and The Scenarios document has been finished. This document outlines decision trees for consumers, such as if you have SSI, this is what happens when you go back to work. The document thus describes how benefits can create barriers and how those barriers can be overcome. Numerous materials such as workbooks, videos, and archived webcasts about employment are now available to the COSPs, and these materials will be used by Peers on site who have been hired part time to work with interested Peers on their own employment goals. Linkage with local VR offices is being discussed, and our state liaison, who is our partner in the Johnson & Johnson project, is very supportive. All state COSPs are now doing supported employment; before TTI there were none. In addition, in a separate, non-tti project, 8 CMHCs have begun doing supported employment as well (several more are close to beginning). Overall conclusions: Through this project Missouri has greatly increased its value of peers. 103 have been trained specifically under this project, with more on the way. An ad-hoc employment team has been created for Missouri. This team consists of members from multiple state departments. TTI has provided the tipping point for thinking about employment on a wide basis. For more information, contact: Virginia Selleck, Ph.D. Director, Office of Transformation; Clinical Director, Comprehensive Psychiatric Services Missouri Department of Mental Health, 1706 East Elm Street, Jefferson City, MO Phone: ; 16

17 Nebraska FY2012 EDI PROJECT: Interagency SE Collaboration with the enhancement of SE functions in ACT teams KEY OUTCOMES: The Nebraska Division of Behavioral Health (DBH) has been working systematically to address and improve Supported Employment (SE) in partnership with State Vocational Rehabilitation (VR). The goal has always been to increase employment opportunities for people with mental illness and/or substance use disorders in Nebraska. One of the goals under the Nebraska behavioral health reform efforts in 2004 was to establish SE programs under all six Regional Behavioral Health Authorities (Regions). By 2007, this was accomplished with all six Regions funding SE and DBH officially approving a service definition. However, based on fidelity monitoring completed in 2010 by the University of Nebraska - Lincoln, it was clear SE needed to be updated. These EDI funds are being used to do this SE updating effort. The work has been focused in the areas of coordinating with VR payment and data processes, updating the Service Definition as well as identifying an ongoing process for Fidelity Monitoring. Coordinating with VR: DBH and VR have had a long working relationship with a Memorandum of Understanding outlining the collaboration. Nebraska has considered implementing the Dartmouth Individual Placement and Support (IPS) under EDI. The SAMHSA Supported Employment Evidence-Based Practices (EBP) KIT was also considered. The Federal VR definition of Supported Employment [Rehabilitation Act of 1973 as Amended, Title I - Vocational Rehabilitation Services; Section 7] is included in the discussion. Challenges to be addressed include: DBH uses expense reimbursement while VR has a combined prospective payment tied to outcomes. Nebraska s target population for SE services expanded from Persons Disabled by Severe and Persistent Mental Illness (SPMI) to people with behavioral health disorders (mental illness or alcoholism, drug abuse, or related addictive disorder). Outcome tracking and fidelity monitoring needs a common data base. Nebraska needs to work out how to braid together the DBH and VR services to improve serving individuals while ensuring the accountability required by each entity respectively. EDI triggered discussions between SE Providers, the Regions, DBH and VR. The training on IPS noted below, the May 10, 2012 EBP workgroup meeting, the SE providers conference call on September 24, 2012, and the January 2, s concerning draft revised service definitions helped Nebraska identify a number of limitations with IPS including: (1) IPS is limited to adults with severe mental illness only; (2) integration of the IPS staff to one or two MH treatment teams covering 90% of the caseload; (3) having a IPS unit consisting of at least 2 full-time staff & a team leader in rural settings; and (4) requiring IPS s office be in close proximity to MH treatment team members with an integrated single client chart. The need to coordinate between SE and treatment is understood. However, the IPS model does not 17

18 recognize SE services as part of recovery oriented systems of care that may be separate from treatment. It also did not recognize all behavioral health disorders or the challenges of delivering services in rural areas. Thus the use of the IPS model in Nebraska is challenging. Despite these limitations, the IPS model provided important guidance and practices that have been incorporated to all aspects of the SE discussion. In addition, EDI has provided a platform for numerous discussions on how DBH and VR can work better as a system. Included within these efforts was a review of Maryland s Milestone Payments, which braids State Mental Health Authority (SMHA) and VR payments. Updating the Service Definition: DBH uses service definitions as a set of statements specifying requirements including the appropriate setting for the work to be performed, licensure, basic description and expectations, length of stay, staffing, hours of operation, desired consumer outcome(s), description of rates, as well as clinical guidelines (admission, exclusions, continued stay, & discharge criteria). The goal to update the SE Service definition has involved working with local, regional and state level stakeholders. It started with telephone interviews with stakeholders including SE providers, VR Counselors, Regional Administrators and others. Updating the definition involved incorporating elements of IPS to allow for future potential transition to this model while ensuring continued compliance with SAMHSA and VR requirements. At this time, the updating process also included creating a separate service definition for Transitional Employment covered under the International Center For Clubhouse Development (ICCD) standards. The ICCD is recognized by SAMHSA as an EBP on the National Registry of Evidence-based Programs and Practices (NREPP) [see: ICCD Clubhouse Model].. The EDI grant paid for IPS training. With assistance from the Dartmouth Supported Employment Center (Lebanon, NH), DBH provided IPS training to the SE Providers under contract with the six Regions. Funds supported fourteen (14) individuals access to the Dartmouth Supported Employment Center Online Course on IPS. One supervisor and one employment specialist from each of the seven SE providers signed up to complete the training between May 14, 2012 and August 10, On June 13, 2012, an overview of IPS was provided to SE managers, employment specialists, consumers, VR staff, and DBH staff. Grant funds were used to assist with travel costs for Regional Representatives, SE providers; and a consumer from each of the SE programs to the meeting in Lincoln, NE. Also the Employment Specialist from each of the three Assertive Community Treatment (ACT) teams attended. A $100 honoraria was paid to each SE consumer participant. o 48 attended including Mark Schultz (Director, State Vocational Rehabilitation) and Scot Adams (Director, Division of Behavior Health). o The presenters were Deborah R. Becker (Debbie) and Sandra Langfitt Reese (Sandy) from the Dartmouth Supported Employment Center, Dartmouth Psychiatric Research Center. o The training included an Overview of Evidence-based Supported Employment; a review of the eight IPS supported employment practice principles; an IPS supported employment principles break-out exercise and a review of the 25 item IPS fidelity scale. On June 14, 2012 the State Consultation on IPS was provided by Sandy Reese with the staff from VR and DBH. A variety of topics were covered including the role of VR in SE; role of DBH in SE; Fidelity Monitoring; Cost Model, how Transitional Employment (TE) Service fit with IPS and data collection. ACT Team employment staff completed the Dartmouth Supported Employment Center Online Course on IPS. Additional ACT training on SE is being considered to help improve employment services consistent with the Tool for Measurement of Assertive Community Treatment (TMACT). Fidelity Monitoring: The Evidence Based Practices Workgroup under the DBH Statewide Quality Improvement Team was chartered by Blaine Shaffer, M. D., DBH Chief Clinical Officer. The EBP Workgroup Charge was to provide recommendations on a consistent and sustainable way of doing fidelity monitoring linked to outcomes on Evidence Based Practices. The May 10, 2012 meeting covered Supported Employment. Participants at the meeting included representatives from DBH, VR, Division of Children & Family Services, Division of Developmental Disabilities, Division of Medicaid & Long Term Care; Lincoln Regional Center; the six Regions, & consumer representatives from the State Advisory Committees on Mental Health and Substance Abuse, and others. 18

19 Recommendations on Fidelity Monitoring for Evidence Based Practices were presented at the Statewide Quality Improvement Team meeting on December 5, There has been discussion on using elements of both IPS and the SAMHSA SE toolkits to create a Nebraska model. To that end Nebraska created a side-by-side of the two models to better understand the differences. (see Appendix on page 43) One of the DBH priorities under the SAMHSA 2012 Block Grant is SE. The goal is to improve the quality of SE services. The Performance Indicator is to create an ongoing process for fidelity monitoring by June 30, The fidelity monitoring will then be completed. Next steps after September 15, 2012 Work continues on these efforts to improve SE in Nebraska. DBH continues discussing these changes with the six Regions [including November 28, 2012 and April 29, 2013]. In addition, State VR and DBH have been meeting regularly (September 25, 2012; October 22, 2012; October 31, 2012; December 7, 2012; January 9, 2013; February 6, 2013; March 25, 2013 and April 16, 2013). The next VR / DBH meeting is scheduled for May 28, It is notable how Mark Schultz, Director of NE Vocational Rehabilitation, continues to personally attend every meeting. Discussions include how to create a cost model braiding funds together and share data in order to improve the quality and outcomes of the SE services. Nebraska continues to address: Transitioning to a braided funding model using milestone payment methods. No Wrong Door \ Any Door approach. The definition of Active Client. When to start counting? When to stop counting? Benefits orientation and benefits counseling process Electronic Data Sharing between DBH and VR. Review of Medicaid Rehabilitation Option services with opportunities to embed SE or a vocational specialists to increase opportunities to work for individuals with SPMI. Job Retention Plan One milestone may be to pay SE providers to prepare a job retention plan. The focus of the plan is on long term supports. The plan would be prepared starting 90 days into a client successfully working a job. At the 120 day time of working, the Job Retention Plan would be completed and VR closes the case. The job retention plan would describe the long term support strategy needed to help this consumer keep the job into the future. The Job Retention Plan would include things like: Specific follow-along supports needed by employer & consumer. The use of natural supports and/or other DBH funded services as needed. The plan does not necessarily require the use of an Employment Specialist. A crisis relapse prevention plan. For more information, contact: James (Jim) S. Harvey, LCSW, Federal Resources Manager Nebraska Department of Health and Human Services, Division of Behavioral Health 301 Centennial Mall South Lincoln, NE Phone:

20 New Hampshire FY2011 EDI PROJECT: Empowering Peers Through Strengthening Supported Employment KEY OUTCOMES: Due to legislation that was passed that prohibited the Bureau of Behavioral Health from contracting with or providing funds to the Dartmouth Psychiatric Research Center, the original proposal for the EDI grant had to be rewritten to eliminate the use of the Dartmouth contract and staff. The replacement proposal consisted of the following statement of work: Develop and implement a Train the Trainer model to assist the sustainability of Supportive Employment; Conduct stakeholder forums to develop Supportive Employment outcome measures that will be reported to the Bureau of Behavioral Health; Provide consultation to Peer Support Agency staff by a consultant well versed in supportive employment services delivered by peer support agencies; Provide ancillary training to CMHC, VR and Peer Support staff to compliment the provision of Supportive Employment i.e. motivational interviewing, job development and stages of change, etc; This EDI award significantly improved lines of communication with New Hampshire s Voc-Rehab agency Act as a clearinghouse for material related to Supportive Employment for the CMHC and Peer Support Agencies; and Convene a multi-agency group to clarify and document areas of collaboration and commonality. The project once again ran into problems getting the necessary approval to expend the fund as the documentation necessary for the Governor and Council was delayed several times until ultimate approval was received on February 8, In the interim, the grant did continue with tasks that it could complete with the 20

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